Non-diphtheria corynebacteria species cause disease in risk populations such as immunocompromised patients and patients with indwelling medical devices. Despite reports of exit-site infection and peritonitis caused by non-diphtheria corynebacteria, these organisms are frequently dismissed as contaminants. During a 10-year observation period, we prospectively identified 8 cases of exit-site/tunnel infections caused by 2 different species of corynebacteria ( Corynebacterium striatum in 5 and C. jeikeium in 3 cases). Four patients experienced a second episode of exit-site infection 3 months (2 cases), 25 months, and 40 months, respectively, after termination of an oral cephalosporin therapy of 4 to 6 weeks’ duration. Non-diphtheria corynebacteria accounted for 9% of all exit-site infections during the study period. All catheter-related infections healed; no catheter had to be removed. The diagnosis of catheter-related non-diphtheria corynebacteria infection may be suspected when Gram stain shows gram-positive rods and with colony morphology and commercial biochemical identification systems. Susceptibility of non-diphtheria corynebacteria to antibiotics may vary, especially in C. jeikeium. Virtually all Corynebacterium species are sensitive to vancomycin. Empirical antibiotic therapy with vancomycin should be initiated while antibiotic susceptibility testing is being carried out. Oral cephalosporin may be an alternative treatment regimen for exit-site infections if sensitive. This study highlights the importance of non-diphtheria corynebacteria as emerging nosocomial pathogens in the population of end-stage renal disease patients on on continuous ambulatory peritoneal dialysis.
the described stencils revealed that 24% of cases were best served with a swan-neck catheter, and 42% required a Tenckhoff-type catheter. Either catheter style was satisfactory in 29% of patients and neither in 5% of cases. Conflicts of exit site with skin creases or folds (41%), belt line (23%), or both (36%) were the most important determinants of required catheter type.
DISCUSSIONCatheter stencils should be used in the preoperative planning stage where the patient can be examined fully dressed in the erect, sitting, and recumbent positions. Because patients exist in all sizes and shapes, it should not come as any surprise that more than one type of PD catheter is needed in the armamentarium to establish successful peritoneal access. The catheter style that results in the best exit-site location without compromising correct pelvic position is the device that should be used.Stencils are an important adjunct to the PD catheter implantation process. They can be designed to incorporate the principles of best practices for optimal peritoneal access and assure accuracy and reproducibility in their application. They are inexpensive, easy to construct, and simple to use. Stencils facilitate the work of health care providers and possess the potential of significant impact on patient outcome.
Patients and their partners differ in their appraisals of sex life and SI. Therefore it is important to consider perceptions of both partners in preoperation discussions.
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